Experience of 56 patients using a retrograde sural neurovascular flap to repair lower limb tissue defects

This study was made to investigate the clinical effects of repairing lower limb defects with an improved retrograde sural nerve flap. From November 1996 to September 2010, a total of 56 patients with soft-tissue defects of the lower limb received improved retrograde sural neurocutaneous flap repair. There were 21 women and 35 men ranging in age from 12-73 years (average age 45.9). Eight patients had dorsal foot defects, five patients had foot bottom defects, four patients had heel defects, six patients had defects around the ankle, and 15 patients had defects below the lower third of the leg. Of these, 10 patients had exposed wounds and six cases had exposed tendons. The size of the surgical repair was between ∼6 cm × 5 cm and ∼25 cm × 9 cm. Four patients retained the donor's sural neurovascular flap and normal sural nerve function, and 10 patients retained the retrograde sural neurovascular flap with a thin layer of muscle. All grafted flaps survived in all 56 patients. Patient follow-up lasted between 3 months and 3 years. The shape and function of their lower limbs were satisfactory. Two-point discrimination detection in the donor area and nerve-control area revealed that the sensory function recovered well in the four patients with retained nerves. The partial necrosis of the distal flap in two patients healed successfully after dressing, and no other adverse reactions or complications were observed. Through clinical treatment of the 56 patients, good experience was accumulated. The operation methods made the flap blood supply more abundant, improved the survival rate, and retained the sensory function of the donor site of the lower limb flap. This reduced the damage to the donor site and made the operation safer.